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Background: The global obesity epidemic has paralleled a decrease in semen quality. Yet, the association between obesity and sperm parameters remains controversial. The purpose of this report was to update the evidence on the association between BMI and sperm count through a systematic review with meta-analysis. Methods: A systematic review of available literature (with no language restriction) was performed to investigate the impact of BMI on sperm count. Relevant studies published until June 2012 were identified from a Pubmed and EMBASE search. We also included unpublished data (n ¼ 717 men) obtained from the Infertility Center of Bondy, France. Abstracts of relevant articles were examined and studies that could be included in this review were retrieved. Authors of relevant studies for the meta-analysis were contacted by email and asked to provide standardized data. Results: A total of 21 studies were included in the meta-analysis, resulting in a sample of 13 077 men from the general population and attending fertility clinics. Data were stratified according to the total sperm count as normozoospermia, oligozoospermia and azoospermia. Standardized weighted mean differences in sperm concentration did not differ significantly across BMI categories. There was a J-shaped relationship between BMI categories and risk of oligozoospermia or azoospermia. Compared with men of normal weight, the odds ratio (95% confidence interval) for oligozoospermia or azoospermia was 1.15 (0.93–1.43) for underweight, 1.11 (1.01–1.21) for overweight, 1.28 (1.06– 1.55) for obese and 2.04 (1.59–2.62) for morbidly obese men. Conclusions: Overweight and obesity were associated with an increased prevalence of azoospermia or oligozoospermia. The main limitation of this report is that studied populations varied, with men recruited from both the general population and infertile couples. Whether weight normalization could improve sperm parameters should be evaluated further. Fil: Sermondade, N.. Hôpital Jean Verdier; Francia. Universite de Paris 13-nord; Francia Fil: Faure, C.. Hôpital Jean Verdier; Francia. Universite de Paris 13-nord; Francia Fil: Fezeu, L.. Universite de Paris 13-nord; Francia Fil: Shayeb, A. G.. University Hospital of Wales; Reino Unido Fil: Bonde, J. P.. Bispebjerg Hospital of Copenhagen University; Dinamarca Fil: Jensen, J. K.. University Department of Growth and Reproduction; Dinamarca Fil: Van Wely, M.. Academic Medical Centre; Países Bajos Fil: Cao, J.. Third Military Medical University; China Fil: Martini, Ana Carolina. Universidad Nacional de Córdoba. Facultad de Ciencias Médicas; Argentina. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Centro Cientifico Tecnologico Cordoba. Instituto de Investigaciones en Ciencias de la Salud; Argentina Fil: Eskandar, M.. King Khalid University; Arabia Saudita Fil: Chavarro, J. E.. Harvard University. Harvard School Of Public Health; Estados Unidos. Harvard Medical School; Estados Unidos Fil: Koloszar, S.. University of Szeged; Hungría Fil: Twigt, J. M.. University Medical Center; Países Bajos Fil: Ramlau Hansen, C. H.. Aarhus University; Dinamarca Fil: Borges Jr, E.. Fertility-Assisted Fertilization Center; Brasil Fil: Lotti, F.. Universita Degli Studi Di Firenze; Italia Fil: Steegers Theunissen, R. P. M.. University Medical Center; Países Bajos Fil: Zorn, B.. University Medical Center Ljubljana; Eslovenia Fil: Polotsky, A. J.. University of Colorado Denver; Estados Unidos Fil: La Vignera, S.. University of Catania; Italia Fil: Eskenazi, B.. University Of California Berkeley; Estados Unidos Fil: Tremellen, K.. University of South Australia; Australia Fil: Magnusdottir, E. V.. University of Iceland; Islandia Fil: Fejes, I.. University of Szeged; Hungría Fil: Hercberg, S.. Universite de Paris 13-nord; Francia. Hôpital Avicenne; Francia Fil: Lévy, R.. Hôpital Jean Verdier; Francia. Universite de Paris 13-nord; Francia Fil: Czernichow, S.. University of Versailles Saint Quentin en Yvelines; Francia. Centre for Research in Epidemiology and Population Health; Francia

A multicentered phase III clinical trial was conducted in seven countries to compare two dosages of depot-medroxyprogesterone acetate (DMPA), 100mg and 150mg, given every 90 days. Contraceptive efficacy and side-effects of both regimens were reported previously. Their effect on vaginal bleeding patterns is the object of this paper. A total of 1216 women were randomly assigned to a dose group and 1156 of them provided a menstrual diary. The comparison of the bleeding patterns is made using a 90-day reference period approach and following the guidelines published by WHO. In addition, the longest bleeding/spotting episode and the longest bleeding/spotting-free interval are calculated over the entire diary length. The only difference found between the two dose groups is a higher incidence of amenorrhea with the 150mg regimen. Overall, there is a high degree of consistency between the reasons given by individual women for discontinuing the contraceptive method and their vaginal bleeding pattern during the 90 days preceding discontinuation. However the data revealed large between-centre differences, both in the incidence of specific patterns, and in the identification by women of bleeding problems as reasons for discontinuation. This last point suggests that the life-table analysis underestimates the true incidence of menstrual irregularities. Comments on the reference period analysis method are made.

Two dosages of depot-medroxyprogesterone acetate (DMPA), 100 mg and 150 mg given every 90 days, were compared in two groups of women with regard to effectiveness, reported complaints and reasons for discontinuation. A total of 1216 women were recruited into a seven-centre, multinational, randomized clinical trial. Follow-up was for a period of one year and resulted in a total of 5507 woman-months of experience of 100 mg DMPA and 5429 woman-months of experience of the 150 mg dose. The study showed little difference in efficacy and side effects between the two treatment groups. Two pregnancies occurred in women receiving 100 mg DMPA giving a Pearl Index of 0.44 per 100 woman-years. None occurred in the 150 mg group. There was no difference in the overall continuation rates between the two groups at one year, being 59.3% in the 100 mg group and 58.8% in the 150 mg group. Except for discontinuation of method use for amenorrhea, the rates of all medical and non-medical reasons given for discontinuation were comparable between the two treatment groups. Women's perception of lack of bleeding was reported as amenorrhea and resulted in discontinuation rates at 12 months for amenorrhea of 7.2% for women receiving 100 mg of DMPA and 12.5% for those receiving the 150 mg dose. Three centres, Alexandria, Karachi and Szeged, made the major contributions to this difference.

A multicentred study was undertaken at three institutions in Hungary, Mexico and Thailand in women of reproductive age to evaluate the effects of full and half doses of HRP112 (depot-medroxyprogesterone acetate (DMPA) plus estradiol cypionate) and DMPA alone on ovarian function, bleeding patterns and HDL-cholesterol levels. Full dose HRP112 contained 25mg DMPA plus 5mg, of estradiol cypionate and the half dose, 12.5mg DMPA plus 2.5mg of estradiol cypionate. The full and half dose DMPA were 25 and 12.5mg respectively. In all, 88 women were recruited in the study and randomized within each centre, to the four treatment groups. Subjects were studied for a control cycle, three one-month injection intervals and followed-up for a further two months. Serum concentrations of estradiol, progesterone and medroxyprogesterone acetate were determined three times a week during the third injection interval and during the two months of follow-up. While the results from all centres indicated that the four preparations were all effective in inhibiting ovulation for at least one month, there were marked between centre differences in pharmacokinetic profiles. More regular bleeding patterns were observed in women who received the estrogen-progestogen combination preparations than in those who received DMPA alone.

A multicentered study was undertaken at three institutions in Hungary, Mexico and Thailand in women of reproductive age to evaluate the effects of full and half doses of HRP112 (depot-medroxyprogesterone acetate (DMPA) plus estradiol cypionate) and DMPA alone on ovarian function, bleeding patterns and HDL-cholesterol levels. Full dose HRP112 contained 25mg DMPA plus 5mg, of estradiol cypionate and the half dose, 12.5mg DMPA plus 2.5mg of estradiol cypionate. The full and half dose DMPA were 25 and 12.5mg respectively. In all, 88 women were recruited in the study and randomized within each centre, to the four treatment groups. Subjects were studied for a control cycle, three one-month injection intervals and followed-up for a further two months. Serum concentrations of estradiol, progesterone and medroxyprogesterone acetate were determined three times a week during the third injection interval and during the two months of follow-up. While the results from all centres indicated that the four preparations were all effective in inhibiting ovulation for at least one month, there were marked between centre differences in pharmacokinetic profiles. More regular bleeding patterns were observed in women who received the estrogen-progestogen combination preparations than in those who received DMPA alone.

The circadian variations and secretory rhythms in prolactin secretion were examined in 10 hyperprolactinaemic and 10 normoprolactinaemic women with or without galactorrhoea in order to establish a clearer picture of this secretion and to find, if exists, correlation between the prolactin level and galactorrhoea. In the normoprolactinaemic women a rhythmical rise and fall were observed within 20 min, with higher values during nocturnal sleeping; these changes were more marked in the galactorrhoeic group. In the hyperprolactinaemic group the diurnal and pulsation changes were less pronounced, galatorrhoea usually being accompanied by a higher degree of hyperprolactinaemia. In galactorrhoeic patients with a normal basal prolactin level, a relative prolactin excess may be reckoned with at certain times. A proportion of these women can in fact then be regarded as hyperprolactinaemic. In the hyperprolactinaemic cases without galactorrhoea, a decreased prolactin sensitivity and milk-forming ability of the breasts may be assumed.